Swine Flu Q & A

Maggie Koerth-Baker is a guest blogger on Boing Boing. A freelance science and health journalist, Maggie lives in Minneapolis, brain dumps on Twitter, and writes quite often for mental_floss magazine.

First off, I want to thank everybody who has contacted me on this. You've all had some great questions. I'm happy to report that I've been able to find answers for most of them. Hopefully, this information is useful--or, at least, educational for y'all.

Second, real quick, I want to clarify that, despite my fascination with viruses, I am not on their side. My heart goes out to the people in Mexico who have lost loved ones to this illness. I also sympathize with people here in the U.S. who are experiencing varying degrees of fear over this thing. I would much rather be talking about the science of viruses as a complete non-sequitur with no news hook at all. But, as the situation stands, I find that information (and, yes, a bit of humor) is the best way to tackle fear.

Now, without further ado, let's get on to the questions...

1. Various Inquiries About Cytokine Storm and Whether It's Going to Kill Us All
The name "cytokine storm" basically describes an over-reaction of a healthy immune system, that causes the body to attack itself. It can be triggered by many things, including viruses, although it's not common for human influenza A virus strains to cause it. Researchers suspect the cytokine storm effect played a roll in the 1918 flu pandemic, and may account for why that flu killed so many young adults, when normally, flu kills people with weak or underdeveloped immune systems: The very young, the old, the sick.

Based on the ages of many of the people dying in Mexico, there's been a lot of concern that the H1N1 swine flu virus is also killing via a cytokine storm effect, with the implication that this flu virus will be as deadly as the 1918 version. But, according to Andrew Pekosz, Ph.D, associate professor of microbiology and immunology at Johns Hopkins Bloomberg School of Public Health, it doesn't look like H1N1 swine flu is causing cytokine storms in its victims.

The most pressing concern with swine H1N1 is not its ability to cause more severe disease, it is its ability to infect large numbers of humans because we don't possess any immunity to this particular novel virus strain. With respect to Mexico, I don't know...nor does anyone as far as I can tell...how many mild disease cases can be attributed to swine H1N1. I suspect there are a lot, in which case the number of deaths (as a percentage of total number of infected people) would be comparable to what we see with seasonal flu. I have no doubt that people have died of respiratory disease in Mexico, but I think we need much more information about how many total cases there are before we can say how virulent the virus is.

In other words, unless information gathering later tells us otherwise, you probably don't need to worry about cytokine storm with this flu virus.

2. Concerning Those Little Surgical Masks...And Other Forms of Prevention
Surgical masks can aid prevention, but only to a point. Viruses can pass through standard surgical masks. You're better off using a specialty mask with the designation N-95 or N-99. Those are available online or at pharmacies. But even that's not perfect. The virus can live for up to 2 hours outside the human body and it's likely to be on any surface an infected person might touch after sneezing, or sneeze on directly. Desks, doorknobs, computers...lots of things. Hand-washing and keeping your hands away from your eyes and face (and, if you have the flu, staying away from everybody else) are still the best ways to prevent transmission.

And, about antiviral medications like tamiflu. Those drugs could, theoretically, work as a preventative measure. But, according to Christine Layton, a public health policy analyst with the North Carolina-based non-profit research institute RTI International, that would be a REALLY bad idea. She says:

Influenza (like other viruses) can become resistant to antiviral medication. When this occurs, antiviral medications are no longer effective. The best way to prevent the development of resistant viruses (or bacteria) is to use antiviral (or antibiotic) medications only when infected with a virus which will respond to the medication."

Another great way to keep from getting swine flu: Don't got to Mexico. The State Department has said that all unessential travel to the area should be avoided. Do what they say, here. Even if it ends up costing you some money on airline tickets, the risk of picking something up---and, perhaps worse, spreading it to family, friends, and everyone you share an airplane with---just isn't worth it. You don't want to be responsible for that.

3. What About the Symptoms and Which are Deadly?
You know how everything seems to start off feeling like the flu? This, too. In fact, the cases in the US have been, essentially, no different from a seasonal bout of flu, like those many of us have already had this year. You get a fever. Your nose runs. You feel like a truck hit you. Then you sleep for a couple of days, eat some saltines, drink some pickle juice*, and you're good.

Obviously, though, this scenario is going down differently south of the border. Some of you wanted to know what, exactly, the flu was doing to kill those people. I'm not having much luck tracking down specifics to these cases, but most likely, the H1N1 swine flu kills people in Mexico the same ways seasonal flu kills 36,000-odd Americans every year. Flu can interact with chronic illnesses (such as asthma or heart disease) to make the symptoms of those chronic diseases worse--sometimes fatally worse. A flu infection can also lead to pneumonia, which inflames the lining of the lungs and fills them up with fluid--making it difficult to breathe, and sometimes causing death. Dehydration from diarrhea, and brain damage from sustained very high fevers, can also kill flu victims.

Even if you do have flu symptoms, the chances of you having swine flu are pretty low, unless you've recently been to Mexico or spend a lot of time around someone who has. In that case, you should call your doctor, rather than going to the hospital or to her office. The best way to keep swine flu from spreading is to keep it away from the public.

And, finally, remember that it's allergy season. I've got a runny nose right now, but if there's no fever and you've still got the energy to go about your regular life, it's probably not the flu at all.

*Or is that just my family?

4. Will There Be a Vaccine?
Apparently, yes. But not anytime soon. Christine Layton tells me that there are companies working on a vaccine for H1N1 swine flu, but the lag time on vaccine production is pretty gnarly. We're talking 3-to-6 months before anything can get out the door, and that's with development and production being fast-tracked. Because flu viruses tend to pretty quick on the mutation draw, the "wild" virus will likely be different from the one the vaccine is modeled on by the time it comes out. That doesn't mean a vaccine won't work, though. Flu vaccines often work on a "close enough" principal. Basically, if the virus the vaccine is based on is similar enough to the wild virus, the vaccine can still help your body mount a defense. It may not prevent illness altogether, but the illness you get might be more mild that what you'd have come down with otherwise.

That said, there's also a distinct possibility that, by the time a vaccine is out, H1N1 swine flu won't be a problem anymore.

5. The $64,000 Question
Many people emailed to ask why a virus that appears to be killing people in Mexico is producing illness that barely warrants a trip to the doctor here. Baby, if I could answer that, my pay grade would be a LOT higher. This is really the big, central mystery right now. And while there is no shortage of speculation, the fact is that (as of this writing) nobody has any frackin' clue. There is, however, a World Health Organization science briefing scheduled for tomorrow. Maybe we'll get some preliminary answers then. But I wouldn't bet on it.

6. "I Have Taken The Amino Acid Sequence of H1N1 Swine Flu and Turned It Into a Piece of Ambient Music. Does This Interest You?"
Yes, Stephan Zielinski. Yes, it does. You can listen to Stephan's appropriately haunting, sad and beautiful composition on his Web site.

Finally, a quote to bear in mind, from Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, as reported by the (hopefully) immortal Canadian Press medical journalist Helen Branswell:

"Anybody who thinks they know what this virus is going to do weeks, months or years from now really doesn't have a clue what they're talking about."

It's possible to take this quote several ways. I choose to look at it hopefully. Let's take worst-case-scenarios--and the people promoting them--with a grain of salt for now.